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Psoriasis Treatment: Systemic vs. Biologic Medication
- By Mikel Theobald
- Reviewed by Pat F. Bass III, MD, MPH
Before deciding which type of drug may be best for you, learn about the benefits and risks of both systemic and biologic medications for psoriasis.
Psoriasis — an autoimmune condition that causes itchy, scaly red patches on the skin — can be tough to treat, and your treatment needs can change over time. When psoriasis doesn’t respond to topical ointments and light therapy, your condition may need a different type of medication. That’s when it’s likely time to talk to your doctor about effective prescription treatment options for moderate to severe psoriasis. The two main types of drugs for psoriasis are called systemic and biologic .
Both types of drugs work by affecting the immune system, but that’s where the similarities end. Not only is their delivery different — typically pill versus injection — but so are the mechanics of how each type of psoriasis drug works, says Soheil Simzar, MD, a dermatologist at Ava MD in Los Angeles and a clinical instructor of dermatology at the David Geffen UCLA School of Medicine.
Systemic Drugs for Psoriasis Treatment
Systemic drugs affect the entire immune system, hence the name “systemic.” You typically take them in liquid or pill form, although some may be given by injection. If you haven’t had success with topical medications or light therapy, or if you have psoriatic arthritis , you’re a potential candidate for systemic drugs, Dr. Simzar says. But because they affect the whole immune system, systemic drugs may not be suitable for women who are pregnant or nursing, for those who are immunosuppressed, or those that have a history of liver issues.
Systemic medications work by suppressing the immune system to reduce or stop the inflammation that causes psoriasis. Different types of systemic drugs perform in different ways. Acitretin, for example, works by slowing down how quickly skin cells multiply, Simzar says. Methotrexate works by interfering with DNA, slowing down the production of new cells.
Side effects of systemic drugs vary as well. “For example, some systemic medications can affect your liver and kidneys, the lipids in your blood, or cause high blood pressure,” says Delphine J. Lee, MD, PhD, a dermatologist and the director of translational immunology at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif. Simzar says that side effects can be as mild as dry lips or as severe as infection, liver toxicity, or even birth defects, which is why they are not prescribed to pregnant women.
Biologic Drugs for Psoriasis Treatment
Biologic drugs are made from living cells in a laboratory, meaning they are genetically engineered. Instead of affecting the entire immune system, biologic medications target specific proteins or cells, such as tumor necrosis factor alpha (TNF-alpha), that have a direct connection to psoriasis. This class of drugs is typically prescribed when other treatments have failed. However, people with psoriasis who also have cancer may not be good candidates for a biologic drug, Dr. Lee says. If you have tuberculosis or another serious infection, biologic medications are likely not right for you either.
Biologic drugs are administered by injection, which you may be able to do at home, or by an intravenous (IV) infusion in a doctor’s office or other medical setting. Simzar says that common side effects range from minor injection-site reactions to flu-like symptoms to more serious respiratory infections. You’ll need to tell your doctor right away about any adverse reactions, and you may need to stop taking the drug if you experience any of these issues.
Not all the side effects of biologics are known yet. “Biologics are a relatively new form of psoriasis treatment , and long-term data and experience with them is limited,” Simzar says. There are concerns that taking a biologic medication might lead to an increased risk for infection or cancer of the lymph nodes (lymphoma), and that they may be associated with heart failure or central nervous system disorders.
What Research Shows About Drugs for Psoriasis
Current guidelines recommend systemic medications as the best option for managing psoriasis when more than 5 percent of the body is affected and for those with debilitating disease affecting genitalia, the palms of the hands, or the bottom of the feet. Psoriasis that affects 5 percent or more of the body is considered moderate; psoriasis that affects 10 percent or more of the body is considered severe. The guidelines, published in 2011 by the American Academy of Dermatology, recommend adding a TNF-alpha inhibitor biologic medication if there’s not improvement in psoriasis symptoms after 12 to 16 weeks of treatment with a systemic drug.
How much longer those guidelines will hold remains to be seen. A four-year study, published in the August 2013 issue of the Journal of Drugs in Dermatology, found that biologic medications were more effective than conventional systemic drugs for treating moderate to severe psoriasis, with a 70 percent improvement versus 40 percent improvement.
The Right Psoriasis Treatment for You
Psoriasis treatment isn’t a one-size-fits-all approach. Various individual factors determine which treatment option may be best for you, including the severity of your psoriasis, if you have any other medical conditions, and your personal needs. Your doctor’s preference and your insurance coverage are likely to factor in as well. Some doctors may be more comfortable prescribing systemic drugs for psoriasis because they’ve been around much longer, Simzar says, and insurance coverage for these medications is often better and easier to deal with.
“In any medical decision-making process, the choice of treatment requires careful consideration of the benefits, risks, and alternatives of the treatments being considered,” Lee says. There are pros and cons to both psoriasis medication options that should be explored. Work with your doctor to determine the most effective psoriasis drug treatment for you.
Last Updated: 8/20/2014
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